Workplace Facilities Issue Report Form
Report workplace facilities problems quickly and efficiently. Please provide detailed information to help us resolve your issue as soon as possible.
Your Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Team
Please Select
Administration
Human Resources
IT
Operations
Sales
Marketing
Other
Location of Issue (Building, Floor, Room)
*
Type of Facility Issue
*
Please Select
Electrical
Plumbing
Heating/Cooling
Cleaning
Furniture
Security
Other
Describe the Issue
*
When did you notice the issue?
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How urgent is this issue?
*
Critical – Immediate action required
High – Needs attention soon
Moderate – Can wait a few days
Low – Not urgent
Upload Photo (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Report
Should be Empty: